Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3018, Submission # Submission-2022-3223, UID # 39619
Status: Compliance Inspection Accepted
 

System Status

System status on date: 03/10/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
090302012000814687 109TH ST N, TOWN OF STILLWATER14687109THSTNSTILLWATERTOWN OF STILLWATER55082MAAS TIMOTHY D & HEATHER K32OTCHIPWE TRAILS2003
Owner's representative:
Name:
Alec Vujovich
Email:
alecsauto@gmail.com

Impact on Public Health

System discharges sewage to
the ground surface:
No System discharges sewage to
drain tile or surface waters:
No System causes sewage backup
into dwelling or establishment:
No
Verification method(s):
Searched for surface outlet
Searched for seeping in yard/backup into home

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
No
Sewage tank(s) leak below their
designed operating depth:
No
Verification method(s):
Examined Tank Integrity Form (Attach)

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
No
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
No
System is non protective of groundwater for other
conditions as determined by the inspector:
No

Date of Install

Date of install known: Yes
Date of installation: 12/03/2013

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a three-foot vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Verification method(s):
Two previous verifications (Attach boring logs)
A. Bottom of distribution media: 2.5 Decimal Feet
B. Periodically saturated soil/bedrock: 6.7 Decimal Feet
C. System separation: 4.2 Decimal Feet
D. Required compliance separation: 2.6 Decimal Feet

Operating Permit and Nitrogen BMP

Is system operating under an Operating Permit: No
Is the system required to employ Nitrogen BMP: No

Comments and File Attachments

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Kloeppner Services & Designs LLCL4043763-843-41143540 Lexington Ave N Ste 203 Shoreview, MN 55126NoNoYesYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: jesse@ksd-mn.com

Terms

Certification
  • By submitting this form I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future
    system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate
    maintenance, or future water usage

Invoice #7826 (03/11/2022)

Charge Cost Quantity Total
Non-Taxable
added 03/11/2022 11:27 AM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 03/11/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 03/11/2022 11:28 AM
4f6059c23bf464f0b875f8593c999623
8d2679884719861464aa8e1435f81973
 
#1 Compliance Inspection AcceptedSarah Borrell - 03/14/2022 12:47 PM
d54e240d329c63579c5102edbe23db25
d98b4df5e1abdd226849af958cabfc4c
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
      Was the letter sent? Yes Compliant/Non-Compliant: Compliant
      Certificate of Compliance:
        Letter of Non-Compliance:
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